Safety in Catheterization
With so many infections abounding in the world this season, it is a good time to think about safety when catheterizing. These are not actions to slow down your process, but subtle changes in techniques that can help you protect yourself.
Handwashing Maintaining hand hygiene is so important to the care of your body, but an activity that is often overlooked. It can feel like you just washed your hands a minute ago, so does it really need to be done again? Well, the answer is yes. Washing your hands is essential to maintaining the cleanliness of your body.
Think about what you did in between washing your hands and starting to catheterize. Did you adjust your clothes, or push your chair from one location to another? It is these simple everyday moves that are often overlooked. You would notice if you accidentally got some food dripping from your hands as that can make a mess, but everyday moves, and touching dirty objects that do not leave a visible stain on your hands are often not noticed. Washing your hands just before touching a catheter is critical to prevent bacteria and viruses from entering the body.
Hand washing is essential when performing intermittent catheterization, when changing an indwelling catheter, suprapubic catheter, or ostomy bag. Even if you are wearing sterile gloves, you must wash your hands carefully before putting on your gloves. Or your caregiver needs to wash their hands prior to doing the change. It is easy to adjust clothing, gather supplies, and position your body before washing hands; however, these activities are woven into the catheterization process so often that hand washing is done too early.
If warm, flowing water and clean towels are not available, the use of hand sanitizer can be a substitute. Getting supplies, positioning, and removing clothing should all be done before washing your hands for catheterization.
Opening Cleaning: No matter what you use to access your urinary system, the urethra or a surgically created opening, you want to clean the area before inserting a catheter. This is for both intermittent, suprapubic, and ostomy care. Research has demonstrated that the largest area for bacterial growth is just inside the opening of the urethra in men. In women, the labia may or may not protect the urethral opening in women. But just knowing that this is a highly contaminated area for men, thinking about body openings is important in any gender.
Cleaning products can leave a residue in the urethral opening. They also tend to dry the delicate tissue at the inside of the opening of the urethra in both genders. Many urinary cleaning products contain alcohol which is very drying. Soap is also drying to internal tissue. Some soaps are pH balanced, which helps control drying.
The internal urethra is a mucous membrane which means it is constantly moist. It is critical that the cleaning process occurs at the opening of the urethra; however, it is just as important to remove the residue when catheterization is complete. A rinse with water can help preserve the moisture in your body. Hand sanitizer or other urethral cleaning products cannot be used as a rinse on the urethra as it contains alcohol which adds drying effects.
Lubricating the Catheter: Adding enough lubrication to a catheter is key to a successful insertion. The tissue in the urethra from the opening to the bladder is a moist mucous membrane. The tissue inside the body is not as hearty as our outer skin, which is used to the elements of life. It is always slightly damp but not moist enough for a catheter to slide easily through.
A lubricant is added to the catheter to help it glide through the urethra without causing minor tears, which can let in infection, or other significant injuries. Some individuals use lubricant sparingly, which is not helping your urethra. A thorough amount of lubricant should be used at the tip of the catheter as well as along the catheter. A drop at the tip of the catheter will not spread along the inserted catheter. It also helps with the withdrawal of the catheter. Men will need to lubricate the catheter six inches or more as their urethra is longer. Women will lubricate a catheter about 2-3 inches.
Pre-lubricated catheters are available for both men and women. This eliminates a lot of the ‘goopy-ness’ of application of the lubricant as well as ensures the entire catheter is well coated. If you have multiple urinary tract infections but have good technique, you may be able to use this as a justification for supplies of pre-lubricated catheters.
Angles When inserting catheters through the urethra, you need to think about taking the straightest route. In men, holding the penis straight up along the abdomen decreases the angle at the penile/scrotal junction internally. When the penis is pointed down, there is a severe angle that a catheter must traverse. When the penis is positioned up along the abdomen, this angle is almost non-existent.
While holding the penis up, you can place your little finger at the base between the penis and scrotum and feel the catheter pass under the skin. The area is quite close to the outer body. This is an area that is susceptible to breakdown, so holding the penis upright is important to avoid pressure injury from the inside of the body due to the trauma of passing the catheter.
Another issue with the penile/scrotal junction is the placement of external catheters. The roll at the top of the external catheter can rub against the penile/scrotal junction, which is why external catheters are secured lower along the penis rather than at the base.
Erosion of the penile/scrotal junction rarely occurs, but some men do have issues. Pressure injury in this location of the body is very difficult to heal which makes it a real challenge.
Further along the route to the bladder for men is the prostate. The catheter has to edge around the angle of the prostate gland. If it is difficult to maneuver the catheter around the prostate, a catheter with a coudé tip can be used. The coudé catheter tip is angled to help find the way around the prostate.
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Women have a bit of a different issue with angles in catheterization. As the labia are held open to create a clear pathway to the urethra, positioning of the fingers holding the labia can distort the urethra opening. There is a natural tendency to separate the labia and pull up. Pulling the labia up changes the angle of the urethra from its straight route to the bladder. This becomes even more of an issue when sitting on a toilet or commode, as the angles can now be changed by pulling up at the labia.
Inserting the catheter through what is now an angled urethra can lead to urethral trauma. The trauma can include slight swelling from forcing in the catheter, which becomes more significant over time. The key to successful female catheterization is to separate the labia but do not pull up toward the abdomen. A labia separator device that opens the labia without pulling up can be purchased. It also can be put into place for the time of the catheterization, so you have two hands available for catheterizing or catheterizing and balancing.
Scheduling: Keep to your schedule for catheterization and fluid intake. Catheterization timing is critical to keeping your kidneys healthy as overflow can occur into your kidneys if your bladder emptying is not regulated. The kidneys do not store urine. They only make it. Storage occurs in the bladder, where the bladder muscle can expand to hold urine. Your kidneys do not store urine, so if it collects there, damage to your kidney tissue occurs. In addition, if urine leaks out of your urethra, you have a good chance of pressure injury as well as social embarrassment.
Fluid intake is also important. If you are using intermittent catheterization, knowing how much fluid you are taking in will prevent backup into the kidneys or overflow incontinence. For others who use a suprapubic catheter or external catheter, it may be recommended by your healthcare provider to take in the extra fluid to keep urine flowing.
Water is the best fluid for urinary health. Sugary drinks, caffeine, and alcohol promote faster urination, filling the bladder more quickly. Nicotine is excreted by the kidneys, which can also affect urinary health.
Adding movement to your legs, either by doing a range of motion yourself or having someone do it for you, will help shake up your bladder for less urinary tract infections.
Keeping your bladder healthy by adjusting your bladder care techniques can actually save time in the long run by keeping your bladder and body healthy. Nurse Linda
Pediatric Consideration:
Learning good techniques of bladder care early helps promote bladder health for a lifetime. Explain to your child what you are doing and why. Help them make good food and fluid choices. Of course, all children want a soda or other drinks occasionally, but help them to use them in moderation. They all appreciate a fun water bottle.
Teens can have challenges with the selection of fluids. Creating a bond with your child will help them make good choices. Nurse Linda